Eligibility Representative, Specialty

This is a fully remote position, open to applicants in United States.

📋 Description

• Verify patient insurance coverage, calculate estimated costs, and document details within patient profiles.

• Enter and update patient demographic information in the system.

• Generate quotes for coverage and financial responsibility, and discuss benefits with patients via phone.

• Track, monitor, and secure the necessary insurance and reimbursement documentation.

• Obtain prior authorizations and coordinate financial assistance forms, payment agreements, and waivers.

• Assist in training new employees during their onboarding process.

• Organize and prioritize daily tasks to achieve productivity and quality standards.

• Create new hospital and physician codes as required.

• Collaborate with internal teams to enhance reimbursement workflows and client services.

• Investigate reimbursement issues and participate in ongoing improvement initiatives.

• Support specialty pharmacy and infusion services in collaboration with hospitals and health systems.

⛳️ Requirements

• High school diploma or GED is required.

• Minimum of 1 year experience in insurance verification, prior authorization, or a related role within a healthcare environment.

• Familiarity with medical terminology.

• Strong computer skills, including proficiency in Microsoft Office.

• Excellent mathematical, communication, and organizational abilities.

• Preferred experience with payer websites and coordination of benefits.

• Preferred knowledge of pharmacy versus medical payers and their authorization processes.

• Preferred familiarity with plan formularies and authorization requirements.

• Reliable cable broadband or fiber optic internet service with at least 10Mbps download and 5Mbps upload speed for remote work.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits available from the first day of employment.

• Access to well-being and behavioral health programs.

• Participation in a 401(k) plan.

• Company-paid life insurance coverage.

• Tuition reimbursement opportunities.

• A minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence available.

• Flexibility for remote work arrangements.

• Internet connection requirements supported through cable broadband or fiber optic service with at least 10Mbps download and 5Mbps upload.